PROJECT SUMMARY Most providers know that one in three US children is overweight. Fewer recognize that severe obesity is developing earlier, cardiometabolic risk factors are seen even in toddlers, and that obesity-related diseases formerly seen only in adults now are diagnosed in children. These risks are reduced, though, in overweight children who attain a normal weight. During primary-care visits, pediatricians have an opportunity to address weight and weight-management. Although the American Academy of Pediatrics and US Preventive Services Task Force recommend that providers identify overweight/obesity, assess medical risk, and use a staged treatment and reassessment approach, little is known about whether performing these recommended clinical practices in routine practice is associated with improvement in weight or metabolic risk factors. The overall objective of the proposed studies is to identify specific clinical practices and reassessment strategies in primary care that are effective in improving weight status and cardiometabolic risk factors among 2-18 year-old children with overweight and obesity. This will be accomplished through three specific aims, which are to 1) identify whether recommended clinical practices for identifying and managing obesity and related conditions are associated with weight-status improvement in 2-18 year-old children; 2) determine whether these recommended clinical practices impact cardiometabolic risk-factor improvement; and 3) examine the impact of three reassessment strategies?no reassessment, more frequent primary-care visits, or nutrition/comprehensive weight-management program visits?on weight reduction and risk-factor improvement. For all Aims, existing data extracted from electronic health records (EHR) will be analyzed to determine clinical practice elements (such as body-mass-index screening, lab assessments, referrals, and follow-up intervals) associated with improvement in weight status and cardiometabolic risk factors. For Aim 2, laboratory results and blood-pressure values will be used to analyze the association of specific clinical practice elements with cardiometabolic risk-factor improvement. In Aim 3, to examine impact of clinical practices from Aim 1 with three reassessment strategies (no follow-up visits for reassessment, more frequent primary-care visits, or nutrition/comprehensive weight-management-program visits), we will study up to six years of longitudinal data regarding relative weight and risk-factor changes through follow-up visits, referrals to nutrition and comprehensive weight-management programs, and return to routine primary care (upon conclusion of referrals and programs). The proposed studies address how to improve overweight/obesity management in primary care, a research priority of NIDDK. The exceptional resources and institutional support at UT Southwestern, outstanding multi-disciplinary team, and proposed studies will inform primary-care interventions to increase high-quality screening and management of overweight, obesity, and related comorbidities, toward the goal of improved long-term outcomes.